CONTINUING EDUCATION

Volume 34 No. 3 Page 90

Endodontic Obturation
Techniques:
The State of the Art in 2015
Authored by L. Stephen Buchanan, DDS

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 CONTINUING EDUCATION
Endodontic Obturation
Techniques
The State of the Art in 2015
Effective Date: 03/01/2015 Expiration Date: 03/01/2018
About the Authors
Dr. Buchanan is a Diplomate of the American Board
of Endodontics, a Fellow of the National and
International Colleges of Dentists, and part-time
faculty at University of California, Los Angeles and
University of Southern Californias graduate
endodontic programs. He is the founder of Dental
Education Laboratories, a hands-on teaching center
in Santa Barbara, where he also maintains a practice limited to convention-
al/microsurgical endodontic therapy and implant surgery. He can be reached
via the websites delendo.com and endobuchanan.com.
Disclosure: Dr. Buchanan has a financial interest in Care Credit, Obtura Spartan,
Axis|SybronEndo, and DENTSPLY corporations.
OBTURATION: THE DRAMA QUEEN OF ENDO
Never was so much time and energy spent in the specialty with
so small an outcome as in our understanding and application of
root canal filling methods. I once saw Drs. Herbert Schilder and
Franklin Weine go after each other on stage at an American
Association of Endodontists (AAE) meeting many years ago, and
their fight was about obturation; specifically, cold lateral versus
warm vertical condensation. When I was just a sprout in dental
school, Dr. Steve Cohen testified to a committee of the US
Congress against Sargenti filling material (with complete photos
of patients missing parts of their jaws).
And it continues to this day. Lateral condensation, a severely
flawed method at best, is the most commonly taught obturation
technique at dental schools worldwide (more about this later),
despite the fact that few of their graduates will use the technique
in practice (60% are using carrier-based methods, most of the
rest are using single-cone obturation) (personal communication,
2005, with Dr. Gerald Glickman, past president of the AAE). The
majority of American endodontists continue to harbor an
irrational dislike of carrier-based obturation (Thermafil
[DENTSPLY Tulsa Dental Specialties]), and most of the dentists
using continuous wave electric heat pluggers with System-B
Heat Sources (Axis|SybronEndo) think they are doing vertical
condensation fills when they hit the button and drive down
through the gutta-percha master cone and sealer. Meanwhile,
1
my friend Dr. Naseem Shah is telling me that we dont actually
need to fill the apical halves of root canals!1 How is it that so
many very intelligent clinicians and academics can disagree so
consistently on this topic?
This confusion, like pretty much everything else in root canal
therapy (RCT), exists because procedural events in a tooths root
canal system during treatment occur on a very small scale; and,
they occur in a space that is obscured from our view, even when
our radiographic imaging is stellar. Overlaying the confusion that
dentists experience in the clinical environment, every dental
companys marketing people spend half of their waking hours
thinking about how to distinguish their obturation products from
the herd of competitors, resulting in a Babel Tower of obfuscation
in print and lecture.
The Path to Mastery
So how do we think our way through these conundrums and
make intelligent obturation choices going forward? To become
clinically successful, we learn the concepts and procedures our
instructors taught, we challenge them with our subsequent
clinical experience, and bit by bit we gain a deeper
understanding of these tiny roach motels that we call root
canals. We practice with diligence, we add and we subtract
procedural steps, we pay unforgiving attention to outcomes,
and then we feed that data back into our model of endodontic
reality, continuing a virtuous growth of our endodontic
experience and skill.
If we are more passive about these choices, we are in-
fluenced by psychosocial factors, ie, where we were trained,
how affluent our patients are (can they afford more time-
consuming methods?), and how successful we think we have
been with previous and current techniques (notice the word
think). Nevertheless, the only predictable path to endodontic
filling nirvana is the scientific route, despite both the severely
limited data that we have and the frequently erroneous
conclusions that we have made and continue to make. So lets
start at the beginning, with the most fundamental treatment
issue of all.
It Begins With a Bug
It all starts with a bug in the pulp. Without bacterial invasion,
pulps rarely cook off.2 So when we consider this carefully, it
becomes crystal clear why, these days, fewer pulps degenerate
3 to 5 years after crown cementation. When I got out of school,
this was common, and we explained to patients that the pulp
was previously injured by decay and the procedure needed to
restore the tooth and that it then slowly atrophied beyond the
threshold of vitality. Today we understand this differently, as
 CONTINUING EDUCATION
Endodontic Obturation Techniques: The State of the Art in 2015
the bonded resin cements that have replaced zinc phosphate
cement not only stick crowns to teeth, but also fill the opened
dentinal tubules of cut tooth structure at the critical cemento-
enamel junction level, dramatically reducing pulp deterioration
3 to 5 years post-cementation.
What we understand now is that 3 to 5 years was how long it
took for zinc phosphate cement to wash out from under any crown
margin less than perfectly adapted to the tooth, creating a path for
bacteria into the poorly defended pulp space. Bonding resins have
also dramatically increased the success of direct pulp capping, since
its all about the integrity of the seal on what is essentially a hard-
tissue sponge with somewhere between 3,000 and 33,000 dentinal
tubules per mm2.
Mysterious Failures
Without bacteria, we have no disease state, so cleaning remains
the most critical aspect of root canal therapy. Ironically, cleaning
procedures are given short shrift by many clinicians in many
ways; the most common mistake being insufficient irrigation
time. It is my belief that the current trend among endodontists
going back to multivisit treatment is due to mysterious failures
that they have seen after doing single-visit RCT without adequate
irrigation time spent. Enterococcus faecalis notwithstanding, these
are virtually all cases that began with severely inflamed pulps, and
the continuing pain episodes unrelieved by antibiotics are caused,
in this case, by pulpal remnants and not by unkilled bacteria, in
my experience. However, the time it takes to digest pulpal
remnants from lateral canal spaces with sodium hypochlorite
(NaOCl) is about the same time it takes to reliably kill bacteria
with NaOCl in a root canal, which is 40 minutes.3
Multivisit endodontic treatment resolves this problem with
the use of chemical warfarecalcium hydroxide paste left in
shaped canals for at least 2 weeks between appointmentskilling
infective agents, and pulp remnants with calcium hydroxide
throughout 2 weeks rather than by the use of NaOCl for 40 minutes
during a single appointment. Either way solves the problem;
however, single-visit RCT is rightly loved by dentist and patient
alike. Nobody wants a long and slow RCT, so effective irrigation and
single-visit RCT is my preferred treatment plan.
On this topic, the change I made recently in my irrigation
routine, using a chelating agent during all instrumentation and
bringing NaOCl efficacy to bear afterwards, has roughly doubled
the lateral anatomy I have seen filled. I made this dramatic change
as I began to better understand the role smeared layer debris plays
in limiting our NaOCl efficacy (Figure 1). So the thrill of the fill
is most seriously affected not by the filling procedure itself, but by
the procedure that precedes obturation and irrigation: shaping.
Because we have no way to assess when our cleaning efforts
2
Figure 1. Radiograph of
TrueTooth (Dental
Education Laboratories)
replica after single-cone
obturation. Note the apical
lateral canal is filled (with
sealer) and the midroot
lateral canal is filled
halfway, simply from the
hydraulic event created as
the cone moved to place
through a thick mix of
Axis|SybronEndos Pulp
Canal Sealer.
have been adequately successful, we fill as completely as
possible to deliver success regardless of whether bacteria re-
main, and we finish RCT by creating a robust coronal seal to
keep future bacterial invasion at bay.
Lateral Condensation? No, Thank You!
If given the choice of having a single-cone fill or a lateral
condensation fill of my own tooth, I would choose single-cone
obturation every time. Contrary to Dr. Schilders calling the
Lateral Condensation technique single-cone filling with a
conscience, my beef with it is that it threatens the most critical
aspect of RCT, which is the tooths structural integrity after treatment.
Think about it. To laterally condense more than a single
accessory cone alongside the master cone of gutta-percha requires
a shape usually cut with Gates Glidden bur sizes 4, 5, and heaven
forbid, even a size 6. Then, after enlarging the canal unnecessarily
(its weaker as a result), we wedge a very inclined-plane of an
instrument we call a spreader tightly between the canal wall and
the cold, unsoftened master cone, and we work it forcefully in an
apical direction to make room for the accessory cone to follow.
Can you say splitting force?
My sister, Dr. Jennifer Buchanan, was taught the Schilder
filling technique at the University of California, San Franciscos
School of Dentistry. One day, during her first clinical year, she called
me to describe a filling technique that was being used at another
school, where the gutta-percha wasnt heated or softened prior to
condensation. It made no sense to her, and she asked me if there
were any other schools that also taught this lateral condensation
obturation method. Funny, huh?
Single Cone Filling? Okay.
Beyond these issues, it is helpful to understand that short lateral
canals can be filled all day long with single-cone obturation
(Figure 1). Of course, this, like every other lateral filling, requires
effective irrigation methods beforehand. Lateral canals are filled
 CONTINUING EDUCATION

Endodontic Obturation Techniques: The State of the Art in 2015

during obturation procedures when an object (be it a plugger, a Figure 2. CT reconstruc-
tion of mesial root of
carrier, or just a gutta-percha cone) is moved into a canal a mandibular molar
containing viscous material that must stream coronally as it is showing the shaping
displaced by the object, thus creating a hydraulic event capable results from landed (left)
and non-landed (right)
of moving sealer into lateral canals. rotary files, both 30-.06
When using the Single-Cone Filling technique, the most sizes but with functionally
effective lateral hydraulic forces are delivered when the master different flute geometry.
Nonlanded rotary files are
gutta-percha cone tightly fits at its tip and closely fits the shape incapable of cutting the
cut into the canal without binding anywhere along the cone, same shape twice, those
short of the cone tip. The most predicable shaping outcomes are shapes ending up signifi-
cantly larger than the
delivered with radial-landed rotary files such as GT Series X cone fit into it, reducing
Rotary Files (DENTSPLY Tulsa Dental Specialties) (Figure 2), lateral hydraulic forces
which cut a consistent shape, allowing cones to fit tight at their exerted on sealer, reducing the potential for filling lateral canals
regardless of sealer viscosity.
tips with only a 0.05-mm gap between master cone and the
primary canal wall (Figure 3). Figure 3. Plastic block with
S-curve; final shape was
cut with a 30-.06 GT Series
Centered Condensation Methods? Yes, Please! X Rotary File (DENTSPLY
I am frequently asked how I rationalize using both The Tulsa Dental Specialties)
(left), after which a .06 GT
Continuous Wave (CW) of Condensation and Carrier-Based Series X Gutta-Percha cone
Obturation techniques in my practice and in my live course (DENTSPLY Tulsa Dental
demonstrations. The answer is simplethey are both centered Specialties) was fit 0.5 mm
from the terminus. Note
condensation methods. In other words, both of these obturation the tight bind at the cone
methods fill lateral canal aberrations with sealer and gutta-percha, tip and the close fit in the
in the same manner, by displacing surplus sealer and thermo- coronal seven eighths of
the canal.
softened gutta-percha coronally as a heated plugger or carrier is
driven through the canal during obturation. It is this
displacement force, this streaming effect, that moves filling
Figure 4. Illustration of
materials laterally (Figure 4). centered condensation
The best conceptual explanation for the mechanics of dynamics. As the electric
centered condensation Ive come up with is that centered heat plugger or carrier is
moved through thermo-
condensation operates like the inverse of impressioning softened gutta-percha, the
hydraulics. Impressions are typically taken with a hard tray that gutta-percha slips and
carries and pushes the heavy-body impression material around slides on the sealer, filling
lateral canal anatomy as
dental structures, and the heavy-body material slips and slides the displaced filling
on the light-body impression material, which captures the material streams coronally.
finest details. Like impressioning, all these actions happen very
quickly. Similarly, the quality of the root canal filling will not
be improved by working at it for a longer length of time.
The physics of CW and Carrier-Based Obturation are similar:
the electric heat plugger and carrier inversely act like the
impression tray, the heavy-body material is thermo-softened gutta-
percha, and the light-body material is the sealer (Figure 5). This is
good to know as it informs us about optimal execution of these 2
Centered Condensation techniques.
The impression tray is not supposed to bind any of the
patients dental structures; neither is the electric heat plugger or held short of their binding points in the canal. This is because
carrier supposed to bind opposite canal walls. These devices once the plugger or carrier binds opposing canal walls,
carry and move the heavy-body material, but they are always condensation of sealer and/or gutta-percha has ended. This is one

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 CONTINUING EDUCATION

Endodontic Obturation Techniques: The State of the Art in 2015

reason I recommend that carrier-based obturators be held Figure 5. Sagitally dissected
1.0 mm short of canal length (more on this later). mesial roots of mandibular
molars showing sealer and
Centered condensation methods are superior to vertical gutta-percha filling the isth-
condensation in simplicity, in predictability, and in the quality of muses between the primary
outcome. This is in no way critical of Dr. Schilders Vertical canals. The left root was
filled with Thermafil
Condensation of Warm Gutta-Percha Obturation technique, Obturators (DENTSPLY Tulsa
because he set the standard for decades. Both centered Dental Specialties) and the
condensation methods described in this paper were designed by root on the right was filled
with the Continuous Wave
Dr. Ben Johnson and me to qualify as next-generation procedural (CW) of Obturation Tech-
upgrades to decrease technique sensitivity by reducing the nique (courtesy of Dr. Robert
number of instruments and procedural steps needed, while still Sharp).
achieving the obturation results that Dr. Schilder taught us to Figure 6. A young
expect. Who knew centered condensation, with its 2- to 5-second mandibular premolar is
seen in CT imaging to
fills, would more consistently move sealer and gutta-percha have apical branching of
(Figures 5 to 7) into lateral canal spaces than a technique that the primary canal. This
required 10 minutes per canal? case was treated with very
little enlargement, as the
primary canal had nearly
The Continuous Wave of perfect shape before it
Condensation Obturation Technique was entered. Before
cutting any dentin in the
This technique has been taught and used by a majority of canal, it was gaged with
endodontists around the world, so most procedural info about Ni-Ti K-files, sizes 20, 30,
it is on the Internet in detail. However, please permit me to and 40, revealing a natural
30-.06 shape, so only a 30-.08 GTX rotary file was used to cut dentinin
review a few of the critical technique issues attendant to the the presence of 17% ethylenediaminetetraacetic acid solutionfollowed by
CW of Condensation Obturation technique. 45 minutes of 6% sodium hypochlorite irrigation soak time. Note the 4
The new, new thing in CW obturation is the elementsfree lateral canal exits adjacent to the primary portal of exit. This was filled with
a GuttaCore Obturator (DENTSPLY Tulsa Dental Specialties).
Obturation System (Axis|SybronEndo) (Figure 8). For the first
time, there is a cordless obturation system that operates exactly Figure 7. Tooth No. 18
was a typical
as the corded version, hitting 300C within 0.5 seconds, then C-shaped second molar
dropping to 200C for the next 3.5 seconds, at which time it separate distal and ML
shuts off to reduce potential overheating of root structure. If canals, an MB loop
between the middle third
further heat is required after the automatic shutoff, simply and orifice of the ML
releasing the switch and pressing it again begins the next 4- canal. The 2 dominant
second heating cycle. canals either crossed
paths, or they met in the
The elementsfree cordless backfilling extruder is identical apical third and abruptly
in nearly every way to the motorized backfilling device in curved in opposite
the standard-setting Elements Obturation Unit (EOU) directions before exiting
the root. I was unable to
(Axis|SybronEndo). The only difference I have experienced is find the MB canal form; however, effective irrigation and CW condensation
that the elementsfree backfilling extruder shuts off after 4 with the elementsfree Obturation System (Axis|SybronEndo) filled it from a
minutes if it is not on the charging stand when it is switched retrograde direction.
on. This can be frustrating if a wait time is required to reheat it Gauge (Lexicon [DENTSPLY Tulsa Dental Specialties]) to .55 mm,
after automatic shutoff; the reason I switch my extruder on these backfill cones will fit ideally in the space left by any of the 4
before I begin cementing master cones, so it is fully heated CW plugger tapers. After tip adjustment, simply coat the backfill
whenever I get to the backfilling procedure. cone with Axis|SybronEndos Pulp Canal Sealer, place it into the
I am still surprised how few dentists who use a System-B, EOU, backfill space left by the CW plugger with a pumping action,
or now an elementsfree system, know about Axis|SybronEndos remove it to recoat it with sealer and after replacing it in the
Autofit Backfill gutta-percha cones (Figure 9). There is a backfilling backfill space, sear it off at the orifice with a CW plugger and firmly
cone sized for each CW electric heat plugger (.06, .08, .10, and 12 condense with a sustained condensation force until the gutta-
tapers), with tips sized at 0.40 to 0.45 mm. When sized in a Gutta percha has cooled and set hard.

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Endodontic Obturation Techniques: The State of the Art in 2015

Figure 8. The new elementsfree Obturation
System (Axis|SybronEndo). The elementsfree
cordless downpack handpiece and backfill
extruder (left and right, respectively) were
designed to accept the same continuous
wave electric heat pluggers and backfilling
cartridges as Axis|SybronEndos Elements
Obturation Unit.
Figure 9. Axis|SybronEndos Autofit Backfill
gutta-percha cones, a size for each CW
plugger size. These provide the most rapid
and predictable backfilling method for
medium and large canalssave the
backfilling extruder for the small canal
backfilling.
Figure 10. GuttaCore obturator is the
first system with a nonplastic, hardened
gutta-percha carrier, simplifying retreatment.
The complex root canal system, seen in
Figure 6, was filled with a single GuttaCore
obturator.

Carrier-Based Obturation Figure 11. Tooth No.

Carrier-Based Obturation is fairly simple, but highly technique
sensitive. There are a just few procedural steps, so each of them
is critical and must be done correctly or poor results can occur.
For instance, if too much sealer is placed in the canal before the
heated obturator is taken to place, the obturator will act as a
squeegee and shove all the surplus sealer out the end of the
canal, which is not good, but worse is not having enough sealer
in the canal prior to placement of the obturator. The carrier and
gutta-percha will move very easily through the canal unless
this dynamic system runs out of sealer coating the canal walls.
In this case, the obturator will arrive at length without gutta-
percha or sealer around its tip. Remember the impression tray
analogywithout the thin-bodied impression material, the
heavy-body material cannot pick up the detail because it doesnt
have the thin-bodied material to grease its way around the teeth.
The same goes for the movement of thermoplasticized gutta-
percha and sealer in centered condensation methods.
Holding the carrier 1.0 mm short of the full length of the
canal creates a safety feedback loop that tells a dentist with the
first post-obturation radiograph that the sealer application was
inadequate, allowing for an immediate redo of the fill; 5 to 10
minutes at the time, but one or 2 hours if the case fails later. Most
endodontists are concerned about gutta-percha wiping off the
carrier when they are placed around a canal curvature, and
nothing could be further from the truth. The only time carriers
are stripped clean of gutta-percha is when sealer is placed
inadequately or if it is over-blotted with paper points prior to
obturator placement.
The latest advance in carrier-based obturation is GuttaCore
obturators [DENTSPLY Tulsa Dental Specialties] (Figure 10).
16, a third molar, had
anatomy similar to a
3-rooted premolara
palatal canal that was
easily entered straight
through the narrow pulp
chamber, and 2 buccal
canals branching off at
45 to 60 angles from
the long axis of the pulp
chamber. Using cordless
downpack and backfilling
devices in this way-back-
there tooth translated a really difficult procedure into a much easier piece
of work.
Instead of the medical grade PEEK polymer used in Tulsas
obturators until recently, their R&D department has finally
created what Dr. Ben Johnson, the inventor of Thermafil, had
envisioned a decade earlier. Although a bit less robust than
plastic carriers, GuttaCore carriers are easier to sever at the
orifice level after placement and much easier to cut out in
preparation for post spaces. As seen in Figure 6, GuttaCore
Obturators, just like conventional carriers, are extremely 3-D.
My prediction is that GuttaCore Obturators will finally
allow endodontists to use Carrier-Based Obturation with their
self-esteem intact. This will be great for allgeneral
practitioners (GPs), endodontists, dental companies, and, of
course, the patients. Most GPs already know Carrier-Based
Obturation to be not only a credible filling method, but an
exceptional way to achieve the thrill of the fill. When
endodontists wake up to carrier filling, they will save
significant amounts of procedural time, especially in molars.
The dental companies will finally get feedback from

5
 CONTINUING EDUCATION
Endodontic Obturation Techniques: The State of the Art in 2015
endodontists who fill with obturators, and obturator
techniques will get better with endodontists expert attention
to procedural detail and the inevitable improvements to
technique that will result. Patients will also benefit, because
nobody wants a long and slow RCT.
CLOSING COMMENTS
How to explain the wide range of opinions among endodontic
specialists? My best guess is that it happens because we know
so little about the procedures that we use to treat root canals,
and because almost nobody dies when RCT fails; at worst, the
patient gets a titanium replacement, and life goes on. If more
people died more often from bad RCT outcomes, there would
be $100 million of research grant money burning a hole in the
National Institutes of Healths pockets to find out every little
detail that influences the success and failure of endo treatment.
Then we would have far fewer disagreements about how to do
it successfully, but as it is, we have to figure most of this stuff
out by empiricism, so arguments will continue.
Advances in the field have given us 2 different ways to achieve
the same, very 3-D centered condensation result in mere seconds;
now both of them are used without cords (Figure 11). So, where do
I see obturation headed in the future? Well, I am still processing
what Dr. Naseem Shah1 has shown; that we can achieve total
6
periapical healing without filling the apical half of the root canal;
provided we use calcium hydroxide treatment between
appointments to disinfect the apical half and then absolutely seal
the coronal half with MTA. Dr. Shah1 theorizes that she is causing
apical regeneration of healthy tissue into the ends of these
previously necrotic canals. I havent seen research confirmation of
that specific outcome, but Ive seen the 50-plus cases she and
Dr. Logani1 wrote about in their paper; all had necrotic canals
with significant peri-radicular lucencies, and nearly every one of
them healed within 2 to 3 years. So, I am getting the feeling that
the big event here is the 100% coronal seal provided by the MTA
placed to midroot level. Everybody in dentistry questions the
longevity of bonded composite sealing. Could it be that we are
seeing unnecessary RCT failures because the coronal seals we
place after RCT are not as robust as we think?!
1.
References
Shah N, Logani A. SealBio: A novel, non-obturation endodontic
treatment based on concept of regeneration. J Conserv Dent.
2012;15:328-332.
2. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical
exposures of dental pulps in germ-free and conventional laboratory
rats. Oral Surg Oral Med Oral Pathol. 1965;20:340-349.
3. Zou L, Shen Y, Li W, et al. Penetration of sodium hypochlorite
into dentin. J Endod. 2010;36:793-796.
 CONTINUING EDUCATION

Endodontic Obturation Techniques: The State of the Art in 2015

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3. The time it takes to digest pulpal remnants from

This CE activity was not developed in accordance with AGD
PACE or ADA CERP standards. CEUs for this activity will not
be accepted by the AGD for MAGD/FAGD credit.
lateral canal spaces with sodium hypochlorite (NaOCl)
is about the same time it takes to reliably kill bacteria
with NaOCl in a root canal, which is about 2 minutes.
a. True b. False

4. When using the Single-Cone Filling technique, the most

POST EXAMINATION QUESTIONS
1. Lateral condensation, a severely flawed method at
best, is no longer the most commonly taught
obturation technique at dental schools worldwide.
a. True b. False
2. The resin cements that have replaced zinc phosphate
cement not only stick crowns to teeth, but also fill the
opened dentinal tubules of cut tooth structure at the
critical cement-enamel junction level, dramatically
reducing pulp deterioration 3 to 5 years post-
cementation.
a. True b. False
effective lateral hydraulic forces are delivered when the
master gutta-percha cone tightly fits at its tip and
closely fits the shape cut into the canal without binding
anywhere along the cone, short of the cone tip.
a. True b. False
5. The physics of Continuous Wave and Carrier-Based
Obturation are similar: the electric heat plugger and
carrier inversely act like the impression tray, the heavy-
body material is thermo-softened gutta-percha, and the
light-body material is the sealer.
a. True b. False

7
 CONTINUING EDUCATION

Endodontic Obturation Techniques: The State of the Art in 2015

6. According to the author, Vertical Condensation is
superior to Centered Condensation methods in
simplicity, in predictability, and in the quality of
outcome.
a. True b. False

7. Carrier-based obturation is complex and highly

technique sensitive with many procedural steps.
a. True b. False

8. Holding the carrier 1.0 mm short of the full length of

the canal creates a safety feedback loop that tells the
dentist with the first post-obturation radiograph that
the sealer application was inadequate.
a. True b. False

8
 CONTINUING EDUCATION

Endodontic Obturation Techniques: The State of the Art in 2015

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questions, please contact us at (973) 882-4700. 2. o a. True o b. False 6. o a. True o b. False
o I have enclosed a check or money order.
o I am using a credit card. 3. o a. True o b. False 7. o a. True o b. False

My Credit Card information is provided below. 4. o a. True o b. False 8. o a. True o b. False

o American Express o Visa o MC o Discover

PROGRAM EVAUATION FORM
Please provide the following (please print clearly): Please complete the following activity evaluation questions.
Rating Scale: Excellent = 5 and Poor = 0
Course objectives were achieved.
Exact Name on Credit Card
Content was useful and benefited your clinical practice.
/ Review questions were clear and relevant to the editorial.
Credit Card # Expiration Date Illustrations and photographs were clear and relevant.
Written presentation was informative and concise.
How much time did you spend reading the activity and
Signature completing the test?
What aspect of this course was most helpful and why?

This CE activity was not developed in accordance with AGD

PACE or ADA CERP standards. CEUs for this activity will not What topics interest you for future Dentistry Today CE courses?
be accepted by the AGD for MAGD/FAGD credit.